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Cutaneous surgeons frequently evaluate and manage soft tissue tumors arising on the head and neck of adults. Of these, the most common tumor is the lipoma, and specific mesenchymal variants of lipoma occur classically on the head and neck. We describe a case of a large spindle cell lipoma of the posterior scalp, in order to highlight the classic location and differential diagnosis of the lipoma variants presenting commonly in this anatomic region. In addition, we review the role of preoperative imaging studies of scalp soft tissue tumors and discuss how imaging may assist the dermatologic surgeon in establishing the diagnosis and designing a rational surgical approach.

Like continuous-wave CO2 laser systems, the newer, high-energy, short-pulse CO2 laser may be effective in vaporizing some of the surface lymphatic vessels, which may in turn seal some of the communicating channels to the deeper cisterns, yielding functionally and cosmetically acceptable results for this difficult disorder. However, given the nature of the lesion, the potential for recurrence exists no matter what modality is chosen.